There is still plausible deniability, I suppose, because this isn’t a direct edict from the Affordable Care Act. But that is a ruse.

The New York Times reports: “Coverage for End-of-Life Talks Gaining Ground.”

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.

But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives.

Notice the obvious ventriloquism here. The AMA supposedly influences the government. But the government obviously influences the AMA—not only in the fact that government agents participate in “discussions” and “meetings,” but also in all the other ways the government has the power to both do favors and make life harder for doctors.

Likewise, the “private insurers” who have already begun funding “advance care planning” discussions are making decisions in a government-produced environment where they have reduced revenue and are being actively encouraged by the government to do exactly what they are doing. Then the government will claim that the Affordable Care Act should “conform” to what the doctors are doing.